Masashi Shimohira1, Hiro Kiyosue2, Keigo Osuga3,4, Hideo Gobara5, Hiroshi Kondo6, Tetsuro Nakazawa3,7, Yusuke Matsui5, Kohei Hamamoto8, Tomoya Ishiguro9, Miyuki Maruno2, Koji Sugimoto10, Masamichi Koganemaru11, Akira Kitagawa12, Koichiro Yamakado13. 1. Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, 467-8601, Japan. mshimohira@gmail.com. 2. Department of Radiology, Oita University, Yufu, Japan. 3. Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, Suita, Japan. 4. Department of Diagnostic Radiology, Osaka Medical College, Takatsuki, Japan. 5. Department of Radiology, Okayama University Medical School, Okayama, Japan. 6. Department of Radiology, Teikyo University School of Medicine, Itabashi, Tokyo, Japan. 7. Department of Diagnostic Imaging, Osaka General Medical Center, Osaka, Japan. 8. Department of Radiology, Jichi Medical University, Saitama Medical Center, Saitama, Japan. 9. Department of Neuro-Intervention, Osaka City General Hospital, Osaka, Japan. 10. Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Japan. 11. Department of Radiology, Kurume University School of Medicine, Kurume, Japan. 12. Department of Radiology, Aichi Medical University, Nagakute, Japan. 13. Department of Radiology, Hyogo College of Medicine, Nishinomiya, Japan.
Abstract
OBJECTIVES: This study aimed to assess the diagnostic accuracy of computed tomography (CT) and time-resolved magnetic resonance angiography (TR-MRA) for patency after coil embolization of pulmonary arteriovenous malformations (PAVMs) and identify factors affecting patency. METHODS: Data from the records of 205 patients with 378 untreated PAVMs were retrospectively analyzed. Differences in proportional reduction of the sac or draining vein on CT between occluded and patent PAVMs were examined, and receiver operating characteristic analysis was performed to assess the accuracy of CT using digital subtraction angiography (DSA) as the definitive diagnostic modality. The accuracy of TR-MRA was also assessed in comparison to DSA. Potential factors affecting patency, including sex, age, number of PAVMs, location of PAVMs, type of PAVM, and location of embolization, were evaluated. RESULTS: The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of CT were 82%, 81%, 77%, 85%, and 82%, respectively, when the reduction rate threshold was set to 55%, which led to the highest diagnostic accuracy. The sensitivity, specificity, PPV, NPV, and accuracy of TR-MRA were 89%, 95%, 89%, 95%, and 93%, respectively. On both univariable and multivariable analyses, embolization of the distal position to the last normal branch of the pulmonary artery was a factor that significantly affected the prevention of patency. CONCLUSIONS: TR-MRA appears to be an appropriate method for follow-up examinations due to its high accuracy for the diagnosis of patency after coil embolization of PAVMs. The location of embolization is a factor affecting patency. KEY POINTS: • Diagnosis of patency after coil embolization for pulmonary arteriovenous malformations (PAVMs) is important because a patent PAVM can lead to neurologic complications. • The diagnostic accuracies of CT with a cutoff value of 55% and TR-MRA were 82% and 93%, respectively. • The positioning of the coils relative to the sac and the last normal branch of the artery was significant for preventing PAVM patency.
OBJECTIVES: This study aimed to assess the diagnostic accuracy of computed tomography (CT) and time-resolved magnetic resonance angiography (TR-MRA) for patency after coil embolization of pulmonary arteriovenous malformations (PAVMs) and identify factors affecting patency. METHODS: Data from the records of 205 patients with 378 untreated PAVMs were retrospectively analyzed. Differences in proportional reduction of the sac or draining vein on CT between occluded and patent PAVMs were examined, and receiver operating characteristic analysis was performed to assess the accuracy of CT using digital subtraction angiography (DSA) as the definitive diagnostic modality. The accuracy of TR-MRA was also assessed in comparison to DSA. Potential factors affecting patency, including sex, age, number of PAVMs, location of PAVMs, type of PAVM, and location of embolization, were evaluated. RESULTS: The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of CT were 82%, 81%, 77%, 85%, and 82%, respectively, when the reduction rate threshold was set to 55%, which led to the highest diagnostic accuracy. The sensitivity, specificity, PPV, NPV, and accuracy of TR-MRA were 89%, 95%, 89%, 95%, and 93%, respectively. On both univariable and multivariable analyses, embolization of the distal position to the last normal branch of the pulmonary artery was a factor that significantly affected the prevention of patency. CONCLUSIONS: TR-MRA appears to be an appropriate method for follow-up examinations due to its high accuracy for the diagnosis of patency after coil embolization of PAVMs. The location of embolization is a factor affecting patency. KEY POINTS: • Diagnosis of patency after coil embolization for pulmonary arteriovenous malformations (PAVMs) is important because a patent PAVM can lead to neurologic complications. • The diagnostic accuracies of CT with a cutoff value of 55% and TR-MRA were 82% and 93%, respectively. • The positioning of the coils relative to the sac and the last normal branch of the artery was significant for preventing PAVM patency.
Authors: D W Lee; R I White; T K Egglin; J S Pollak; P B Fayad; J A Wirth; M M Rosenblatt; K W Dickey; C M Burdge Journal: Ann Thorac Surg Date: 1997-10 Impact factor: 4.330
Authors: Salim A Si-Mohamed; Alexandra Cierco; Delphine Gamondes; Lauria Marie Restier; Laura Delagrange; Vincent Cottin; Sophie Dupuis-Girod; Didier Revel Journal: J Pers Med Date: 2022-06-30